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Protein . Energy Malnutrition.pptx
- 1. Protein Energy Malnutrition Prof.Osaretin A.T. EBUEHI, PhD, MBA, FNIFST, FNSBMB, FAMedS, FIPAN , FIELPN Deputy Provost, CMUL Department of Biochemistry, College of Medicine, University of Lagos, Nigeria Email: oebuehi@unilag.edu.ng
- 2. 1. What isProtein Energy Malnutrition 2. Causes of Protein Energy Malnutrition 3. Types of Protein Energy Malnutrition 4. Treatment/Management of Protein Energy Malnutrition 5. Effects of Protein Energy Malnutrition 6. Strategies for promoting proper nutrition in the community OUTLINE
- 3. Protein Energy Malnutrition Protein Energy Malnutrition (PEM) is the deficiency of macronutrients or energy and protein in the diet. It is a nutritional disorder, which affects all the segments of population like children, women and adult males particularly from the backward and downtrodden communities.
- 4. The causes ofPEM can either be direct or indirect. Direct causes The direct factors, which are commonly referred to as immediate factors include: (i) Inadequate food intake Inadequate food intake is the result of limited access to food in terms of quality and quantity. (ii) Diseases Diseases notably malaria and measles lead to loss of appetite, increased rate of metabolism due to fevers thereby increasing the body’s nutrient demands. Diarrhoea reduces the absorption of food nutrients, whereas vomiting decreases food intake. Intestinal parasites compete for nutrients Causes of Protein Energy Malnutrition
- 5. Indirect causes (i) Foodinsecurity and limited access to foodstuffs • Families cannot acquire or produce enough food to cater for energy needs. • Lack of or limited access to land or agriculture inputs, marketing and distribution of foods. • Loss of food through destruction by pests, fungi, rodents, birds and wild animals. Soil erosion, often resulting from overstocking, deforestation and discriminate burning. • Poor farming practices often due to lack of knowledge, money, time or equipment. • Poor weather conditions like failure of rains, floods etc. • Lack of time to gather food, prepare it properly and provide special dishes for young children. Among the time consuming and energy – expending activities of the rural African housewife are the fetching of water from long distances. Causes of Protein Energy Malnutrition
- 6. Indirect causes (ii) Poorwater / sanitation and inadequate health services. • Health services may be of low quality, expensive, non-existent or unfriendly. • Lack of pre-natal and child health care. • Inadequate management of sick children. • Inadequate water and sanitation facilities. (iii) Inadequate maternal and childcare practice. • Families do not give adequate time and resources for women and children’s health, dietary and emotional needs. • Poor caring practices, including the inappropriate care of sick children. • Not utilizing health care facilities for special needs of pregnant mothers or adolescent girls. Causes of Protein Energy Malnutrition
- 7. Protein-Energy-Malnutrition takesdifferent forms which include: Clinical forms o Kwashiorkor o Marasmus o Marasmic kwashiorkor Sub-clinical forms Underweight Wasting Stunting Different Types of PEM Types of Protein Energy Malnutrition
- 8. Underweight (Mild PEM) Beingunder weight for age is a common form of malnutrition in children, whereby the child weighs less than normal children of the same age and sex. Most of them are between the age of 1 to 3 years. They grow and develop more slowly than well-nourished children and are “at risk” of illness, and these illnesses are more serious than in well-nourished children. This mildest form of PEM can be detected only by checking the weight of the child and plotting it on the Growth Chart. Clinical signs of underweight The remarkable sign is that the child may look thinner and smaller compared with other children of the same age and sex.
- 9. Wasting and Stunting(Mild or Moderate PEM) Children with mild or moderate PEM do not have the gross oedema of kwashiorkor nor the emaciated appearance of nutritional marasmus. But they do have evidence of malnutrition and they are at special risk of developing the more severe forms of PEM, or of succumbing to an infectious disease. In most communities in Africa fewer than 5% of children at any one time have kwashiorkor or nutritional marasmus. In these same communities usually at least 30% and sometimes as high as 75% of children have mild or moderate PEM. These present as wasting and stunting. A child is said to be wasted when their weight is less than children of the same height and sex. A child is stunted if their height is shorter than children of the same age and sex. The main feature of mild or moderate PEM is a failure to grow and develop optimally. Anthropometric measurements are used in determining these conditions.
- 10. Kwashiorkor Kwashiorkor isan African (Ghanian) word, meaning a "disease of the displaced child", who is deprived of adequate nutrition. Mostly occur in children between the ages of 1 and 3 years, when they are completely weaned (taken off the breast). The three essential manifestations or signs of kwashiorkor are: 1. Oedema (swelling of feet) 2. Growth failure, and 3. Mental changes.
- 11. Clinical signs ofkwashiorkor Oedema: accumulation of fluid in the tissues. Usually begins with a slight swelling in feet gradually spreading up the legs. Later, hands and face may also have oedema. Poor growth: Growth retardation is the earliest manifestation. The child will be lighter and shorter than its normal peers of same age and weigh about 80% or less of their normal peers. Sometimes, in cases of gross swelling, the body weight may be relatively higher. The child will also be wasted (thinner). The child's arms and legs will appear thin as a result of wasting. Mental changes: kwashiorkor child has no interest in the surrounding. The child will also be irritable and prefers to stay at one place and in one position.
- 12. Other signs whichmay be present are Hair changes: In kwashiorkor, the hair loses its healthy sheen and becomes silkier and thinner. It takes coppery red colour (referred to as 'discoloured hairy). You could easily pluck small tufts of hair without causing any pain (referred to as easy pluck ability) just by passing your hands through the hair. Skin changes: In many cases, dermatosis (changes in skin) is seen. Such changes are common in areas of friction. Moon face: The cheeks may seem swollen with fluid or fatty tissue and often be slightly sagging. Micronutrient deficiencies: Almost all the children manifest anaemia (due to iron deficiency) of some degree. Eye signs of vitamin A' deficiency are also common. Manifestations of vitamin B complex deficiency are also noted in many cases.
- 14. Marasmus Marasmus iscommon in children below the age of 2 years. The marasmic children are so weak that they may not have even energy to cry, which most often is barely audible. The child is extremely wasted with very little subcutaneous fat with the skin hanging loosely particularly over the buttocks. Oedema is absent and there are no skin and hair changes. However, frequent diarrhoeal episodes leading to dehydration and micronutrient deficiencies of vitamin A, iron and B-complex are common.
- 15. Signs andSymptoms of Marasmus Extreme muscle wasting - "skin and bones" Loose and hanging skin folds Old man's or monkey faces Absolute weakness
- 16. Effects of PEMin children The effects of under nutrition on children are potentially serious, depending on how severe it is, how long it lasts, and the age the child. Children with severe kwashiorkor and marasmus: • Often die. Kwashiorkor is particularly difficult to treat. • Have poor growth and development. • Are often anaemic and suffer from xerophthalmia, an eye condition that can eventually end in blindness. • Have poor academic performance and attendances of children at school.
- 17. Marasmic Kwashiorkor Sometimes,in areas where PEM is common, malnourished children exhibit the features of both kwashiorkor and marasmus. Such changes could occur during the transition from one form of severe PEM to another. These children will have extreme wasting of different degrees (representing marasmus) and also oedema (a sign of kwashiorkor). Signs and symptoms of Marasmic Kwashiorkor Extreme muscle wasting - "skin and bones" Loose and hanging skin folds Old man's or monkey's face Absolute weakness Oedema
- 18. Biochemical signs specificto PEM Biochemical Changes Marasmus Kwashiorkor Serum albumin Normal or slightly decreased low Urinary urea per g of the creatinine Normal or decreased low Urinary Hydroxyproline Index low low Serum free amino acid ratio Normal Elevated Anaemia May be observed Common iron and folate deficiency may be associated Pancreatic secretions Reduced enzymatic activity Reduced enzymatic activity
- 19. Effects of PEMon adults Adults with severe PEM: • get mental disorders. • get low blood pressure. • are very weak and non-productive in the community
- 20. Effects of PEMon the population As malnutrition has wider causation, its effects are also multidimensional in nature. These include: • Ill health and disease. • Poor productivity of the malnourished individuals. • High health budgets at household, district and national levels. • Poverty perpetuation (a vicious circle). • Poor growth and development of children. • Poor academic performance and attendance of children at school. • Poor obstetrical performance in females due to stunting, hence obstructed labour.
- 21. Treatment Diet Treatment ofcases of kwashiorkor or marasmus involves mainly providing appropriate nutrition support. The child should receive a diet that provides adequate amounts of energy and protein. Both of these are required in larger quantities than normal. The child should be given the following concentrations: Energy : 170 - 200 kcal per kg of body weight Protein : 3 - 4 g/kg of body weight Vitamin and mineral supplements All cases of severe PEM require multivitamin preparation to meet the increased demands during recovery. Iron (60 mg) and folic acid (100 mg) may be given daily to correct anaemia.
- 22. Treatment Oral rehydration Sincediarrhoea is very common in severe PEM, correction of dehydration is the first step in the treatment. Home made (salt-sugar mixture) or commercial oral rehydration solution (ORS) can be administered to correct dehydration. Intravenous fluids are required only in severe dehydration. Control of infections and infestations Appropriate antibiotics should be started immediately since infections are the immediate cause of death in many children. Children with intestinal infestations Like giardiasis and ascariasis should be treated. "prevention is better than cure". So it becomes extremely important that we make sincere efforts to prevent and control PEM
- 23. Strategies for promotingproper nutrition in a community Good nutrition is apparent when a child is getting enough food in quality and quantity. The following strategies can be employed to counteract malnutrition: Proper education • Basic education is a pre-requisite to child nutrition and care. Therefore advocacy should be done for equal chances of education for both boys and girls to make better parents/caretakers. • Spreading knowledge on nutrition and child health in schools, families, communities etc should be done, to improve on attitudes and practices, with emphasis on proper nutrition in the most vulnerable groups that is, the mothers and children. • Sensitization of communities on the importance of adequate intake of nutritional supplements.
- 24. Strategies for promotingproper nutrition in a community Healthy environment • Availability and easy access to safe and adequate water for drinking, cooking, cleaning etc. • Safe disposal of wastes like using latrines and proper disposal of refuse. • Vector and vermin control is important for nutrition and general health.
- 25. Strategies for promotingproper nutrition in a community Maternal and childcare • Prevention of low birth weight (< 2.5kg) and prematurity through adequate antenatal care for safe motherhood. For example, proper nutrition and supplementation, preparation for successful breast feeding, de-worming and non-drug/alcohol abuse. • Prevention of intrauterine infections such as malaria and HIV infection through community sensitization. • Proper ante-natal care for example, conducting safe delivery and care for the new-born. • Promotion of exclusive breast-feeding in the first 6 months of age, and complementary feeding after 6 months at the same time continuing to breast-feed at least up to 2 years. Breastfeeding of children born of HIV positive mothers should be done according to HIV infant feeding guidelines.
- 26. Strategies for promotingproper nutrition in a community Healthy social and family life • Family size: All children are more likely to receive enough attention and food if the family is small. Therefore, modern family planning methods should be encouraged as to have quality families or children. • Younger children need to be accorded more care. If both parents are away efforts should be made to give children enough food and attention by the caretaker. • Distribution of money, work and food within the family should be equitable. For example, pregnant mothers and growing children need more high quality energy and protein foods for their increased body demands. However, children need this food in small portions frequently, because they can’t digest large quantities of food at once. Secondly, pregnant mothers should have light exercises and enough rest. • Care for children from broken, incomplete or underprivileged families should be done through social integration and communal care.
- 27. Strategies for promotingproper nutrition in a community Proper agriculture • Allocation of money and other resources for agricultural improvement, education and health. • Create conditions for accessing land for cultivation and growing of enough food. • Clearing of land at the right time. • Planting of the right and different seeds (diversification) and weeding should be ensured if one is to get optimal and value harvest. • Irrigation and use of fertilizers should be employed where needed and advice sought from agricultural extension workers. • Harvesting at the right time and proper handling of harvests through storage, processing and preparation so that nutrients are preserved and there is enough food in times of hunger. • Communal production and fair distribution/marketing of food for equity purposes through women groups and co-operative societies. • Creation of jobs for those who do not have access to land so that they can have income to purchase food.
- 28. Strategies for promotingproper nutrition in a community Public health measures • Prevention and treatment of perinatal infections of mothers and babies especially Chlamydia, HIV and sexually transmitted diseases. • Immunization against vaccine preventable diseases like measles, tuberculosis, and whooping cough which contribute to malnutrition in children. • Emphasis on growth promotion and monitoring activities using the “Child growth curve” and initiate remedial measures for faulty growth. • Early detection and effective treatment of acute diseases like diarrhoea and acute respiratory tract infections can be used to prevent or control malnutrition. Child with severe PEM should be identified and referred to appropriate referral units/nutrition rehabilitation centres for expert management.
- 29. References http://www.nutrition.gov/home/index.php3 Nutrition facts and information Basic Biochemistry By Prof. OA.T. Ebuehi, 2012, p304 THANK YOU